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HB2940 - 572R - H Ver
House Engrossed
AHCCCS; eligibility;
verification; SNAP; contractors
State of Arizona
House of Representatives
Fifty-seventh Legislature
Second Regular Session
2026
HOUSE BILL 2940
AN
ACT
Amending Title 36, chapter 29, article 1,
Arizona Revised Statutes, by adding sections 36-2930.07 and 36-2930.08;
Amending title 41, chapter 57, Arizona Revised Statutes, by adding articles 2
and 3; amending title 46, chapter 2, article 2, Arizona Revised Statutes, by
adding section 46-232; relating to public benefits.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it
enacted by the Legislature of the State of Arizona:
Section
1.
1. Title
36, chapter 29, article 1, Arizona Revised Statutes, is amended by adding
sections 36-2930.07 and 36-2930.08, to read:
START_STATUTE
36-2930.07.
Health benefit purchasing organizations
A. Notwithstanding any other law to
the contrary, subject to the approval of the centers for medicare and medicaid
services, the administration shall contract with health BENEFIT purchasing
organizations to manage the provision of services to members. A health benefits
purchasing organization may include:
1. a Retailer.
2. a Membership organization.
3. a Cooperative.
4. a Trade or fraternal association.
5. any other health plan.
B. a health benefits purchasing
organization shall be licensed under title 20 and must demonstrate solvency,
maintain claims reserves, comply with all fraud controls and accept the
administration's published fixed BENEFIT pricing.
END_STATUTE
START_STATUTE
36-2930.08.
Fixed benefit price list; reimbursement; provider disclosure;
explanation of benefits
A. Notwithstanding any other law to
the contrary, subject to the approval of the centers for medicare and medicaid
services:
1. The administration shall publish
and annually update a fixed benefit price list.
2. each contractor shall reimburse
health care providers at or above the rates on the fixed benefit price list.
B. each health care facility and
HEALTH care provider that receives reimbursement pursuant to this article shall
disclose a fixed benefit price list based on billing codes for common services
provided pursuant to this article.
C. Each member shall be mailed an
explanation of benefits itemized by billing code after each service.
END_STATUTE
Sec.
2.
2.
Heading
change
The chapter heading of title 41,
chapter 57, Arizona Revised Statutes, is changed from "MISCELLANEOUS"
to "STATE AGENCIES GENERALLY".
Sec.
3.
3. Title
41, chapter 57, Arizona Revised Statutes, is amended by adding articles 2 and
3, to read:
ARTICLE
2. ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM
START_STATUTE
41-5911.
Definitions
In this article, unless the context otherwise
requires:
1. "Administration" means
the Arizona health care cost containment system administration.
2. "Department" means the
Arizona health care cost containment system.
END_STATUTE
START_STATUTE
41-5912.
Eligibility verification; required sources; data sources queried;
conflicting data; application status; department employees not in compliance
A. unless expressly required by
federal law, the department may not approve, renew or continue eligibility for
any applicant or enrollee in any program administered by the department without
affirmatively verifying all eligibility factors using documentary evidence or
trusted electronic data sources.
B. Eligibility verification for any
program administered by the department shall include, at a minimum, all of the
following for each applicant or enrollee:
1. Income.
2. Residency and physical address.
3. Citizenship or qualified
immigration status.
4. Household composition, applied
when applicable.
5. Incarceration status.
6. Death records.
7. All property ownership or transfer
when reported or identified through data matching.
C. The department shall query
multiple independent state and federal databases before approving or renewing
an application. Authorized data sources include the following:
1. the Department of revenue.
2. the Arizona department of
transportation, motor vehicle division.
3. the Department of economic
security wage databases.
4. the state Department of
corrections and county jail systems.
5. County recorder and assessor
records.
6. The social security
administration.
7. The systematic alien verification
for entitlements system.
8. Any other lawful state or federal
database.
D. Eligibility for a program
administered by the department shall be automatically reevaluated on detection
or reporting of any of the following:
1. Income or employment changes.
2. Out-of-state residency
indicators.
3. Property acquisition or sale.
4. Incarceration or release from
incarceration.
5. Death record confirmation.
e. If the department receives or
discovers data that appears to be conflicting, the application shall be placed
in pending status or be denied or benefits shall be terminated until the
conflict is resolved. Cases that qualify as high-risk for benefits fraud
shall be referred to the department's office of inspector general.
f. The administration shall maintain
a system in which each query or action is saved separately and not superseded
by a subsequent query or action. the system must provide an audit log for the
Auditor General that identifies:
1. The databases queried.
2. The data returned.
3. The eligibility rules that were
applied.
4. The basis for the approval or
denial of an application or application renewal or the termination of benefits.
g. Any employee of the department who
has been found through an audit log to have wilfully not complied with the
eligibility verification requirements prescribed in this section shall be
immediately terminated.
END_STATUTE
ARTICLE 3. ARIZONA
HEALTH CARE COST CONTAINMENT SYSTEM
and
DEPARTMENT of economic security
START_STATUTE
41-5921.
Unified eligibility rules engine; eligibility source
A. The Arizona health care cost
containment system and the department of economic security shall jointly
procure and operate a unified eligibility rules engine that is capable of at
least the following:
1. Real-time verification
across all programs administered by both agencies.
2. Identification of risk events that
either increase oR decrease the use of programs or spending on programs.
3. Event-triggered reviews of
eligibility.
4. Full audit log access as
prescribed by section 41-5912, subsection f.
B. The system procured pursuant to
subsection A of this section is the authoritative eligibility source for the
Arizona health care cost containment system and the supplemental nutrition
assistance program.
END_STATUTE
START_STATUTE
41-5922.
Quarterly reports; joint legislative audit committee; auditor
general; audit logs; confidential briefings
A. The Arizona health care cost
containment system and the department of economic security shall submit
quarterly reports to the joint legislative audit committee detailing:
1. Program eligibility approvals and
denials.
2. The frequency of Data conflict
flags.
3. Improper payment estimates in the
current fiscal year.
4. The number and circumstances of
referrals to law enforcement.
B. The auditor general may request
audit logs from the Arizona health care cost containment system and the
department of economic security without a subpoena. The auditor general shall
provide the joint legislative audit committee with confidential briefings
relating to the auditor general's findings from the audit logs received.
END_STATUTE
Sec.
4.
4. Title
46, chapter 2, article 2, Arizona Revised Statutes, is amended by adding
section 46-232, to read:
START_STATUTE
46-232.
Eligibility verification; self-attestation prohibited;
coordination; department employees not in compliance
A. The department of economic
security shall apply the same eligibility verification standards required
pursuant to section 41-5912 for all new and renewal applications for the
supplemental nutrition assistance program.
B. The department of economic
security may not accept any self-attestation during the eligibility
verification process unless expressly required by federal law.
C. The department of economic
security shall integrate the eligibility system for the supplemental nutrition
assistance program with the Arizona health care cost containment system's
eligibility verification system prescribed in section 41-5912 and the
department of revenue's wage databases.
D. Any employee of the department of
economic security who has been found through an audit log to have wilfully not
complied with the eligibility verification requirements prescribed in section
41-5912 shall be immediately terminated.
END_STATUTE
Sec.
5.
5.
Legislative
findings and intent
A. The legislature finds
that:
1. Public benefit programs
must operate under proof before payment, not postpayment recovery.
2. Self-attestation
without verification has materially contributed to fraud, waste and improper
payments.
3.
Medicaid
procurement practices have restricted competition and inflated costs through
noncompetitive insurer-provider arrangements.
4. Taxpayers are entitled
to transparent pricing, auditable eligibility determinations and market
competition.
B. The legislature intends
to restore fiscal integrity, eliminate systemic fraud and reintroduce
competitive discipline into this state's public health care programs.
Sec.
6.
6.
Short
title
This act may be cited as the
"Arizona Secure Benefits Integrity Act".